AHCA/NCAL and more than 100 other organizations
submitted a letter to members of Congress to work with stakeholders on implementing long-term, substantive payment reforms to the Medicare Part B Physician Fee Schedule (PFS) payment model. Specifically, the groups urged Congress to conduct hearings as soon as possible to begin exploring potential payment solutions to ensure America’s seniors continue to receive access to the high-quality care they deserve.
The Medicare Part B PFS pays for physician and non-physician clinician services when provided to beneficiaries in an office, a facility, the beneficiary’s home. In the SNF setting, consolidated billing requirements mandate that all physical and occupational therapy and speech-language pathology services furnished to nursing facility residents not eligible for Part A benefits be billed under Part B by the SNF.
The letter was spurred by the increasing inadequacy of PFS payment rates. The letter explains that:
“According to an American Medical Association analysis of Medicare Trustees data, when adjusted for inflation, Medicare payments to clinicians have declined by 22% from 2001–2021.” Additionally, the coalition letter states that the PFS “…lacks an annual inflationary update” even though providers, including SNF, “…contend with a wide range of shifting economic factors, such as increasing administrative burdens, staff salaries, rent, and purchasing of essential technology.”
Under the current statutory limitations, the absence of an annual inflationary update, combined with statutory budget neutrality requirements, is ultimately impacting the ability of clinicians to care for Medicare beneficiaries, or for SNF or AL residences to obtain essential services for their residents. As emphasized in the letter:
“These year-over-year cuts, combined with a paucity of available alternative payment/value-based care models, clearly demonstrate that the Medicare payment system is broken. These systemic issues will continue to generate significant instability for health care professionals moving forward, threatening patient’s timely access to essential health care services.”